4926 Johnson Dr., Shawnee Mission, KS 66205
Office Hours: Monday-Friday 9-5
Available by phone 24/7
913-384-5566

Vital Statistics Form

Please fill this form out as much as possible. It will help us to complete the death certificate and in writing the obituary. All fields with an asterisk are required.

Deceased's Information

If residence, please include address
mm/dd/yyyy
English, Irish, French, German, etc.
Be specific
Primary occupation during working years. *Do not enter \"retired\".
Sales, Medical, Engineering, Construction, etc.
Please list survivors and relationship: son, daughter, brother, sister, etc.
Religious affiliations, fraternal and civic organizations, hobbies, etc.

Informant's Information

A copy of what is submitted will be sent to this email.
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Obituaries & Condolences

Linda R. Burt (Robbins)

Nicholas Michael Rodriguez

Connie Ann Albrecht

Judith Virginia Rose

Margaret “Peggy” Reyner Smith

Elaine Lierly Jones

Mary Louise (Mockler) Terril

Patricia Rose Smith (Creathbaum)

Kerry Lenore (Chalmers) Ray

Donald Philip Kilgore

Jeffrey S. Dennis

Ruth Elaine (Walker) Achelpohl